Which comes first: PACU or ICU?

[wannabecnl]

I'm in my first year of nursing school, and so far I have loved the ICU, the CRNA was my favorite role in the OR, and I'm hoping for a full PACU day but have taken 2 patients to the PACU and loved it, too.

I've seen threads on this board where people said that to be a good PACU nurse, you need ICU experience. However, I just read another thread saying that ICU was better prep for CRNA than PACU because it involved more skills; this would suggest that to be a good ICU nurse, you should start in the PACU.

So, experienced PACU and ICU nurses, I am not trying to start a war , but I am interested in both of these areas. Can you tell me which path seems most helpful? Thanks!

[pacurn60]

One of my CPAN (certified post anesthesia nurse) nurses got into CRNA school without ICU experience. He had worked in PACU for 4 years before he decided to go to CRNA school and they accepted his PACU experience as ICU experience but we work with critical patients. Hemodynamic monitoring- SVO2, a-line, PA, CVP etc.

[sukiathome]

that is the difference then. Most PACUs do not work with the above. ICU will help no matter where you work. It gives you a better understanding of the complexities and how to make rapid decisions. (on your own) I've worked with a few nurses that never worked ICU and everyone of them want to automatically call "a CODE" or "a rapid response" In the ICU you learn how to handle problems before they become CODES or you are the rapid responder. Our manager now realizes this and will NOT even interview anyone if they do not have ICU background.

[lterry]

You need to work in ICU first!! In PACU you need to be able to handle any patient including ICU patients receiving anesthesia. Much better to learn ICU skills and learn PACU skills!!

[GHGoonette, BSN, RN]

Now, here's something scary for you to chew on; in our ICU, we make use, predominantly, of agency staff (yeah, makes nonsense of the term "continuity of care", doesn't it?) and many of these characters know less about ICU than I do! I won't deny the value of certain skills in a PACU, but where I live, I have yet to meet the ICU nurse who knows as much about anaesthetics as I do! It's a moot point, however; US colleges have their criteria for admission, and they mostly want people with lengthy ICU experience.

[Sand_Dollar, BSN]

I am a student nurse and work as a tech in the Pre-op & PACU of a University hospital. My love however is critical care and ICU. I have done a lot of asking around and discovered that almost all of our nurses that work in the PACU came from the ICU. In a surgery load of say 45 patients, we might 10 or more patients that will be going into the ICU. The PACU nurses have to know not only the stuff that applies to everyone such as airway, pain control, etc but they must also know what to look for when things get complicated. We get neuro patients who needs checks Q15, I've seen ICP drains and been around when a seemingly regular patient started a downward slide and was rushed to ICU instead of the floor. Knowing what to do and when, especially when a patient is critical, is hugely important and a skill that I believe you have to develop with experience.

All the nurses have asked me what I want to do for my Senior placement and our hospital's new nurse residency program. I tell them that although I love the schedule (no nights or weekends except if on call), the nurses I work with, and the huge variety of cases that I see in the PACU, I want to start off in the ICU. This choice will give me a solid foundation if I ever want to come back to the PACU as a nurse.

As you can tell, I think ICU is the way to go. You see stuff some critical patients in the PACU, but nothing compared to seeing them everyday in the ICU.

Good luck which ever way you go, and I hope you get to check out that PACU soon. :)

[wannabecnl]

Update 2+ years after my original post... I did end up visiting the PACU and LOVED IT. Loved it so much that I applied for and got into a PACU clinical immersion for my 2nd year of school (and recovered C/S patients and others during my OB rotation even before that). Loved that, too, along with my masters work in the same unit.

PACU is what I do, it's my favorite part of the patient experience, and it suits how my mind works: I am good at drilling down and focusing hard on one or two people and then moving on. I've had many PACU nurses all along the way tell me (or my clinical professors) the same thing: "She GETS it. She GETS what we do."

The end result is that I am just now starting to work in the PACU at a good-sized urban acute care hospital. I'm green as heck, but I have taken all of this advice (and advice from friends/colleagues/random PACU nurses that I meet) into consideration, and I am very focused on addressing my weaknesses. I have a good feel for the PACU flow, but I know that the "nursey" stuff (that sixth sense about what is going on/wrong, prioritizing, etc.) is going to need a lot of honing and time. This unit is supportive and willing to take on the project of a newbie who loves it and wants to learn. (They are also happy to have someone they can train to do it "their way!")

Incidentally, I tried to go the ICU route first, knowing it would be invaluable experience for PACU. I applied to numerous ICU jobs (at hospitals known to hire new grads, and positions where no experience was required) to no avail, and when this opportunity arose, I decided to go for it. No complacency here; I will have to work very hard to be the kind of nurse I want to be, but even my first few days have been like coming home.

Thank you for all the input! And for clarification, I never intended to become a CRNA; I was just trying to feel out the differences between ICU and PACU. I didn't make that clear in my first post...